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General NPI Number Information
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NPI Number | 1265297642
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Entity Type | Organization
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Legal Business Name | IDENTITY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 593 S LIVINGSTON AVENUE
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City | LIVINGSTON
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State | NJ
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Zip | 07039-0703
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Country | US
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Telephone | 973-577-5921
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Fax | 888-686-2968
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Provider Business Mailing Address
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Address Line | 593 S LIVINGSTON AVENUE
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City | LIVINGSTON
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State | NJ
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Zip | 07039
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Country | US
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Telephone | 973-577-5921
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Fax | 888-686-2968
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH RUSZKOWSKI
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Credential | DPT
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Telephone | 973-577-5921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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